Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
Ron Loeppke MD, MPH, FACOEM, FACPM President
American College of Occupational and Environmental Medicine
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities
How Occupational and Environmental Medicine
can serve as a vital connecting link between Accountable Care Organizations and the Patient Centered Medical Home
Content Attestation and Disclosure
I am an employee and shareholder of U.S. Preventive Medicine and the content in my presentation, is unbiased,
and to the extent possible, evidence-based.
Today’s Session
Discuss OEM opportunities/roles ACOs/PCMH initiatives: ACOEM’s Position Statement paper in April issue of JOEM on ACOs/PCMH/OEM
How OEM physicians can help ignite employer centered ACO and PCMH deployment
The unique role of Occupational and Environmental Medicine (OEM) in prevention, care delivery and population health management
How OEM can help transform our “Sick Care” system to a true Health system
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
ACOEM Position Statement on Occ Health in ACOs/PCMHs
ACOs/PCMH Definitions
• Accountable Care Organizations (ACOs) • Care model that makes physicians and hospitals more accountable • Outcomes oriented, performance-based with aligned incentives • Goal: improve value of health services, control costs, improve quality • ACOs share in a portion of any savings gained
• Patient Centered Medical Home (PCMH) • “Whole-person” and “Whole Population” orientation • Integrated and Coordinated Care • More emphasis on quality, safety, better access to physicians • Aligned incentives for improving health as well as better clinical outcomes Population Health Management: Better Health, Better Healthcare at Lower Cost
ACOs/PCMH and the Workplace
• Employer communities/workplaces are impacted – Large percentage of Americans receive health benefits at work
• 137 million employees in the U.S. • Retirees and families of employees extend impact even further
– Employers increasingly attuned to health of employees and dependents • Strong evidence base showing that improving health improves productivity
and lowers total health related costs
• Including workplace in ACO/PCMH development is logical – Work impacts health and health impacts work – Workplace is organically connected to home as personal health risks aren’t left
at home just as occupational risks aren’t left at work… – Employers have unique infrastructure advantages that could help ACO/PCMH
initiatives.
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
• Occupational Health Providers are an important resource – Nation’s specialists in workforce/workplace health and wellness – Critical link to nation’s workers and their dependents – An Occ Health Provider/Workplace Wellness Program yearly impact w/
employees = Hundreds of hours; a primary care physician yearly contact w/patient only minutes.
• Occupational Health relevance and sphere of influence is expanding – Workplace health and wellness initiatives now reach millions of workers – Unique training and skills in both individual health and population health
management – Clinical guidelines and scientific research base increasingly relevant – Emphasis on Prevention is fundamental to Occupational Health as well as
ACOs/PCMH
Unique Advantages of Workplace Wellness and Occupational Health
Why are these concepts getting so much attention by employers? The Cost Crisis has been largely driven by the Health Crisis
Employer’s goal is a healthier, more productive workforce at lower total costs
ACOs/PCMH initiatives align incentives for better population health on the supply side (providers) and employers align incentives on the demand side (consumers)
Background: ACOs/PCMH
Of the $2 trillion spent on U.S. health care
The Cost Crisis due to the Health Crisis
In public programs, treatment of chronic diseases constitute an even higher portion of spending:
More than 96 cents in
Medicare… …and 83 cents in Medicaid
Of every dollar spent…
…75 cents went towards treating patients with one or more chronic diseases
“The United States cannot effec0vely address escala0ng health care costs without addressing the problem of chronic diseases.”
-‐-‐ Centers for Disease Control and Preven2on
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
• 133 Million Americans have one or more chronic conditions
• 79 million Americans have pre-diabetes (yet, < 7% are aware of it)
• 67% of the increase in health care spending is due to increased prevalence of treated chronic disease
• 27% of rise in healthcare costs associated with the increase in
obesity rates (‘Waist Line impacts the Bottom Line’)
Source: K.E. Thorpe, Health Affairs 24, no.6 (2005): 1436-1445; and K.E. Thorpe et al., Health Affairs 23, no. 6 (2004): 480-486.
The Problem
The Bigger Problem: The Full Cost of Poor Health
Iceberg of Full Costs from Poor Health on Employers
Sources: Loeppke, R., et al., "Health and Produc2vity as a Business Strategy: A Mul2-‐Employer Study", JOEM.2009; 51(4):411-‐428. and Edington DW, Burton WN. Health and Produc2vity. In McCunney RJ, Editor. A Prac2cal Approach to Occupa2onal and Environmental Medicine. 3rd edi2on. Philadelphia, PA. LippincoY, Williams and Wilkens; 2003: 40-‐152
Personal Health Costs Medical Care Pharmaceu/cal costs
Produc2vity Costs Absenteeism Short-‐term Disability Long-‐term Disability
Presenteeism Over/me Turnover Temporary Staffing Administra/ve Costs Replacement Training Off-‐Site Travel for Care Customer Dissa/sfac/on Variable Product Quality
Top 10 Health Conditions by Full Costs For Employers (Med + RX + Absenteeism + Presenteeism) Costs/1000 FTEs
$0 $50,000
$100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000
Depression Obesity Arthritis Back/Neck Pain Anxiety GERD Allergy Other Cancer Other Chronic Pain
Hypertension
Presenteeism Absenteeism Drug Medical
Loeppke, R., et al., "Health and Produc2vity as a Business Strategy: A Mul2-‐Employer Study“. JOEM. 2009;51(4):411-‐428.
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
As Health Risks go so go Health Costs
Dr. Dee Edington
Zero Trends
$0
$3,000
$6,000
$9,000
$12,000
19-34 35-44 45-54 55-64 65-74 75+
$1,776 $2,193 $2,740
$3,734 $4,613 $5,756
0
$2,565 $3,353
$4,620
$6,625
$7,989 $8,927
$5,114 $5,710
$7,991
$10,785 $11,909 $11,965
Annual Medical Costs
Age Range
Edington. AJHP. 15(5):341-349, 2001
Low Med Risk
High
Which Matters More on Costs: Age or Health Risk?
Health Risks Impact Productivity
% of Workplace Produc2vity Loss
0-‐2 risks 3-‐4 risks 5+ risks
14.7%
20.9%
26.9%
6.4 Days
9.3 Days
12.6 Days
1 risk 3 risks 4+ risks
Work days lost / Person / Year
STD Days / Year
0-‐1 risks
2-‐ 3 risks
4+ risks
2.4 Days 5.3
Days
13.1 Days
Sources: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005; Wayne Burton, MD, IHPM North American Summit Mee/ng 2000; also Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
The Solution
Shi`ing Costs
Actual Cost Decrease
Reducing the burden of health risks and illness leads to a healthier popula/on and measurable TOTAL COST DECREASES.
Current system focus on the financial transac/ons of healthcare has not lowered total costs — it only shiYed them.
Prevention is a Key Solution
Centers for Disease Control and Prevention has found that: 80% of Heart Disease and Type II Diabetes as well as 40% of Cancer are Preventable
– if people just: » stopped smoking, » ate healthy and » exercised
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
Whole Population Health Management
Total Population
Medium Risk Low Risk High Risk
DM Risk LS Risk
Population of One
21
Population Health Risk Transitions after 2 Years on a personalized Prevention Plan
N = 7,804 Par2cipants
Loeppke, R; Edington,, et.al. “The Associa2on of Technology in a Workplace Wellness Program with Health Risk Factor Reduc2on” Journal of Occupa2onal and Environmental Medicine: March, 2013
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
498
2291
5531 4666
Significant Overall Reduction in Health Risk of Population
Net Movement of Health Risk Levels in Cohort Baseline vs Year 2 on Prevention Plan
1775 847
N = 7,804
Low Moderate High
60%
11%
6%
29% 23%
71%
Loeppke, R; Edington, etal. “The Associa2on of Technology in a Workplace Wellness Program with Health Risk Factor Reduc2on” Journal of Occupa2onal and Environmental Medicine: March, 2013
$215 Risk/Year
Costs
Increased
Costs
Redu
ced
Reduced Risk à Reduced Cost
Source: Edington, Zero Trends, 2009 and Edington, AJHP. 15(5):341-‐349, 2001.
$800
$400
$200
$0
<$200>
<$400>
<$800>
-‐3 -‐2 -‐1 0 1 2 3
Risks Reduced Risks Increased
Average Saving (per Risk Reduced per person per year)
$950 Risk/Year
% of Produc2vity
Change
Reduced Risk à Improved Productivity
6% 4% 2% 0% -‐2%
# of Health Risk Changes
Source: Burton, W. et. al. The Associa2on of Health Risk Change and Presenteeism Change. JOEM. Volume 48, Number 3, March 2006, pp 252-‐263.
Average Productivity Savings (per Risk Reduced per person per year)
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
Wellness Works and Prevention Pays
Average ROI
$3.27 + $2.73 Med/Rx Absenteeism
Savings Savings
$6.00 saved for every $1.00 invested
In Comprehensive Wellness
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Affairs (Millwood). 2010; 29(2).
OEM Roles Expanding
Occupational Medicine
• Urgent care focus • Physical exams • Workers’ Comp. • On Site Clinics • Primary Care • Pre-placement,
periodic, medical surveillance exams
• Hazardous/toxic evals • Hearing conservation • regulatory compliance • Case/Disability
management • Efficient SAW/RTW
Occupational Health
• Workplace Wellness
• Health Protection (safety ) and Health Promotion
• Ergonomics • Individual Health
Risk Assessment • Organizational
health assessment
Population Health
Integration of: • Health management • Disease
management • Disability/Absence
management • Medication
management • Value (quality/cost)
management • Managing the health
assets and human capital of workforces and populations
Loeppke, R. Prevention and Managed Care: The Next Generation. Journal of Occupational and Environmental Medicine. 1995 37(5):558-562.
Vision for the Future
Permission to Drs & Pts Misaligned Incen/ves for Sick Fragmented/Uncoordinated Preven/on a Cost to Jus/fy
Benefits Paid for Poor Health EEs “Use it or Lose it” Pa/ents Passive Recipients “Pay for Quan/ty/Volume”
“Sick Care” System Quan/ty/Cost of Service Illness & Injury Health “Benefit” as a Cost
Empowerment of Drs & Pts Aligned Incen/ves for Health Integra/on / Coordina/on Preven/on as an Investment
Rewards Paid for Befer Health EEs “Use Wisely & Save” Consumers Ac/ve Par/cipants “Buy Quality/Value” of H&P
True “Health” System Quality/Value of Service Well-‐being and Produc/vity Value and Benefits of Health
Focus
Approach
Results
Current Way New Way
Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "
Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii
We Can Start Integrating OEM with ACOs/PCMH Now
• Employer sponsored ACOs/PCMHs for workers and their families • Financial opportunities to support health behavior change • “Whole person” and “whole population” integrated health services • Primary, Secondary and Tertiary Prevention services • Work fitness and disability prevention and management • Onsite OEM clinics or full-service primary care clinics • Evidence Based Medical Practice guidelines (clinical & functional)
Key Point: INDIVIDUAL and POPULATION HEALTH MANAGEMENT is a fundamental building block of ACO/PCMH models and OEM physicians
have unique training and expertise with proven results
The Time to Engage is Now
Good Health
is Good Business
The Bottom Line